When Should a Patient with a Nonvariceal Upper Gastrointestinal Bleed Be Fed?

Nonvariceal upper gastrointestinal hemorrhage is a common cause for admission to the intensive care unit. Most patients are prohibited from oral or enteral feeding for 72 hours despite different risks for rebleeding. Fasting is believed to improve the ability to control intragastric pH, stabilize clots, and reduce the risk of rebleeding; however, studies have shown no difference in intragastric pH and complications in patients who received early feeding. Approximately 50% of patients are classified as low risk for rebleeding and can be safely fed immediately and discharged early, even on the same day as endoscopy. Only the patients with a high risk of rebleeding should be kept nil per os and be hospitalized for at least 72 hours after endoscopic treatment. Most high-risk lesions become low-risk lesions within 72 hours, and most rebleeding occurs within this time. Randomized controlled trials have demonstrated that early feeding does not have adverse consequences, however. More studies on the timing and type of nutrition in patients with high-risk stigmata are needed.